Risk assessment in service provider communities

On-line service delivery undertaken between clients and service providers often incurs risks for both the client and the provider, especially when such an exchange takes place in the context of an electronic service market. For the client, the risk involves determining whether the requested service will be delivered on time and based on the previously agreed Service Level Agreement (SLA). Often risk to the client can be mitigated through the use of a penalty clause in an SLA. For the provider, the risk revolves around ensuring that the client will pay the advertised price and more importantly whether the provider will be able to deliver the advertised service to not incur the penalty identified in the SLA. This becomes more significant when the service providers outsource the actual enactment/execution to a data centre–a trend that has become dominant in recent years, with the emergence of infrastructure providers such as Amazon. In this work we investigate the notion of “risk” from a variety of different perspectives and demonstrate how risk to a service owner (who uses an external, third party data centre for service hosting) can be managed more effectively. A simulation based approach is used to validate our findings

Delivering Better Housing and Employment Outcomes for Offenders on Probation

The report ‘Delivering better housing and employment outcomes for offenders on probation’ presents the findings of qualitative research which included fieldwork in six probation areas with professionals involved in the delivery of housing, employment, training and education

Intimate Partner Violence in Omaha

While the greater Omaha area has an extensive network of service providers addressing the needs of Intimate Partner Violence (IPV) survivors and has made great strides to increase collaboration and outreach, opportunities exist to enhance service delivery according to this report

Pay for Success: The First Generation - A Comparative Analysis of the First 10 Pay for Success Projects in the United States

Nonprofit Finance Fund (NFF) has released a comprehensive free report on the first 10 Pay for Success (PFS) projects that have launched in the United States. This report details how and why communities have applied this new approach to address critical social issues including early childhood education, homelessness, and criminal justice and recidivism. Pay for Success is an approach to contracting that ties payment for service delivery to the achievement of measurable outcomes. In the U.S., all of the current PFS projects have been accompanied by a form of social innovation financing, often referred to as a Social Impact Bond, in which investors provide upfront financing for the delivery of services and are repaid only if the services achieve a pre-agreed upon set of positive outcomes. The report includes a series of comparative graphics and observations on the market's development to-date. It examines project goals and project design; the partners and stakeholders involved; the underlying data, evidence, and evaluation plans; the governance and investment structures, including repayment terms and investor profiles; and project costs. To create the report, NFF drew on experience as a PFS educator, partner, and investor and conducted research using project documentation, publically available information, and stakeholder interviews. Over the past five years, NFF has conducted more than 200 PFS trainings, presentations, webinars, workshops, and convenings across the country for service providers, governments, and investors. NFF also manages the Pay for Success Learning Hub, www.payforsuccess.org, the leading national repository for education and information on Pay for Success. NFF's work on the report was made possible with the support of the Corporation for National and Community Service's Social Innovation Fund (SIF)

Innovations that Address Socioeconomic, Cultural, and Geographic Barriers to Preventive Oral Health Care

This report focuses on nine oral health innovations that integrate service delivery and workforce models in order to reduce or eliminate socioeconomic, geographic, and cultural barriers to care. Two additional reports in this series describe the remaining programs that provide care in non-dental settings and care to young children. Although the programs are diverse in their approaches as well as in the specific characteristics of the communities they serve, a common factor among them is the implementation of multiple strategies to increase the number of children from low-income families who access preventive care, and also to engage families and communities in investing in and prioritizing oral health. For low-income children and their families, the barriers that must be addressed to increase access to preventive oral health care are numerous. For example, even children covered by public insurance programs face a shortage of dentists that accept Medicaid and who specialize in pediatric dentistry.(Guay, 2004).The effects of poverty intersect with other barriers such as living in remote geographic areas and community-wide history of poor access to dental care in populations such as recent immigrants . Overcoming these barriers requires creative strategies that address transportation barriers; establish welcoming environments for oral health care; and are linguistically and culturally relevant. Each of these nine programs is based on such strategies, including:-Expanding the dental workforce through training new types of providers or adding new providers to their workforce to increase reach and community presence;-Implementing new strategies to increase the cost-effectiveness of care so that more oral health care services are available and accessible;-Providing training and technical assistance that increase opportunities for and competence in delivering oral health education and care to children;-Developing creative service delivery models that address transportation and cultural barriers as well as the fear and stigma associated with dental care that may arise in communities with historically poor access.The findings from the EAs of these programs are synthesized to highlight diverse and innovative strategies for overcoming barriers to access that have potential for rigorous evaluation that could emerge as best practices. If proven effective, these innovative program elements could then be disseminated and replicated to increase access for populations in need of preventive oral health care

New York Nonprofits in the Aftermath of FEGS: A Call to Action

As with any industry, nonprofits in the human services sector close and merge, but recently, there have been many questions about why so many have disappeared. 18 percent of New York City's human services providers were insolvent in 2013. With the closure of FEGS, it became clear that action was needed, both to examine systemic issues in the sector and to respond quickly and be an active partner with government in addressing this problem. Although FEGS was a unique organization and its collapse was due to a number of different factors, its bankruptcy took place against the backdrop of a broken system in which there is a severe mismatch between program expectations and available funds. Too many nonprofit entities do not have the systems in place to appropriately assess risks, undermining their ability to evaluate government proposals, real estate, and other financial and programmatic decisions. This report serves to provide urgently needed attention to the looming crisis

Progress and opportunities in lesbian, gay, bisexual and transgender health communications

This article describes elements of effective health communication and highlights strategies that may best be adopted or adapted in relation to lesbian, gay, bisexual, and transgender (LGBT) populations. Studies have documented the utility of multidimensional approaches to health communication from the macro level of interventions targeting entire populations to the micro level of communication between health care provider and consumer. Although evidence of health disparities in LGBT communities underscores the importance of population-specific interventions, health promotion campaigns rarely target these populations and health communication activities seldom account for the diversity of LGBT communities. Advances in health communication suggest promising direction for LGBT-specific risk prevention and health promotion strategies on community, group, and provider/consumer levels. Opportunities for future health communication efforts include involving LGBT communities in the development of appropriate health communication campaigns and materials, enhancing media literacy among LGBT individuals, supporting LGBT-focused research and evaluation of health communication activities, and ensuring that health care providers possess the knowledge, skills, and competency to communicate effectively with LGBT consumers

Working Report #2: Client and Community Relations (Service Provider Perspectives)

This report addresses two important questions: how much emphasis is placed on building positive relationships with families and communities across agency based, integrated service, and community and school based models of service delivery? And, how successful is each model at building relationships, minimizing stigma for families, and improving the image of child welfare in the community? Educating clients and the community about child welfare services was identified as an important role for workers in some sites and not in others. While families’ fears of child protection services were a concern, some workers also expressed a fear of their clients and feared for their own personal safety in their work. Service providers within each model seemed to be oriented to different aspects of relationship building and also had different advantages and disadvantages. For example, community based and school based models provided unique forums for engaging with clients and other service providers. Heightened awareness and concern about stigma in many agency based settings was noted; while, in community based and school based settings workers saw themselves on the front-line of improving the agency’s image and building relationships with the community

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study

Background: Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. / Objectives: To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). / Design: A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. / Setting: Twelve general practices and three community settings in London. / Main outcome measure: HIV SSK return rate. / Results: Stage 1 – the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 – of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. / Limitations: Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. / Conclusions: Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. / Future work: Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. / Study registration: This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. / Funding: The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care